By Peter W. Butler, MHSA
More than six years after it was signed into law, the Affordable Care Act continues to arouse strong opinions and strong objections. Consider, for instance, the viewpoint made clear by the title of a Sept.11 Chicago Tribune editorial, “Why Obamacare Failed.”
Simply dismissing the ACA as a “failure,” however, is not supported by the facts when considered in the context of what Obamacare, as the ACA is more widely known, set out to accomplish. According to the obamacarefacts.com website, the goal of the Affordable Care Act is to “give more Americans access to affordable, quality health insurance and to reduce the growth in U.S. health care spending.”
Although some of the editorial made valid points about problems with state health insurance exchanges (marketplaces), especially in Illinois, the exchanges are a small part of Obamacare. The Tribune editorial board appears to have reached its conclusions based on premium increases and the limited number of choices available on the state exchanges.
How the ACA has helped
This view ignores a wide array of peer-reviewed data that examines the full impact of the ACA. These data and evaluations present a health care system that is performing much better than it was prior to the enactment of the ACA.
Consider the following improvements:
With respect to coverage, the U.S. Census Bureau announced on Sept. 13 that the percentage of uninsured people in the United States has decreased to 8.6 percent after the ACA’s third open enrollment period, down from greater than 16 percent four years ago. More than 20 million additional people now are insured. In Illinois, the expansion of Medicaid and the marketplace has provided insurance coverage to around 800,000 residents who previously were uninsured.
With respect to costs, taxpayer spending on Medicare has had per enrollee annual spending increases that have averaged around 1 percent from 2010 to 2015, significantly below the 3.6 percent average annual increases from 2000 to 2010. This new baseline has led to dramatically lower estimates of federal spending on health care than the initial Congressional Budget Office projections when the ACA passed.
As for employer insurance — which includes 150 million people compared to only 10 million covered by all of the state exchanges combined — the average premium grew by only 3 percent and 4.6 percent respectively in 2014 and 2015.
With respect to health delivery reform, the ways in which hospitals and physicians are being paid are dramatically changing. Payments from public and private insurers alike are now linked to data-based measures of quality and safety, along with incentives to reduce unnecessary treatments. Hospitals have responded by investing in information technology and care coordination models that can provide the right treatment at the right time in the right place.
Problems are fixable
Unfortunately, Obamacare carries the stigma of having been passed with no votes from any Republican. With President Obama no longer in office next year, both sides of the aisle will need to look at each other, responsibly, and address what should be fixable problems with the marketplaces.
No one would benefit from taking away coverage from the newly insured or reversing payment reforms that have shown measurable impact. Health care remains too expensive and too complicated, but we are better positioned than ever to deliver on the promises of what sound, federally supported health policy can deliver.
Peter W. Butler, MHSA, is professor and chairperson of the Rush University Department of Health Systems Management. He was chief operating officer of Rush University Medical Center from 2004 to 2013 and the Medical Center’s president from 2010 until his retirement earlier this year.